On November 8, 2016, the American people made an historic choice and elected the ultimate outsider as president of the United States: Donald Trump.

President-elect Trump will likely put forth many policies that differ from the Obama administration. This includes healthcare and the Affordable Care Act (ACA), which Mr. Trump has said he would like to repeal and replace with health savings accounts (HSAs).

“Ultimately, I do not believe Mr. Trump will be able to overturn the ACA,” said Jay Reddy, the president and CEO of VitreosHealth. “There are too may care model pilots and initiatives that are showing great results. The overall goal of the ACA is to transform American healthcare from a fee-for-service model to a value-based care model. However, Mr. Trump’s election will create confusion and delay decision-making, which will give more time to “inefficient” providers and payers to continue doing what they’re doing and not make any changes.

“What will change is the goal of providing insurance coverage and healthcare for all.”

President-elect Trump’s campaign website also stated that he will:

  • Work with Congress to create a patient-centered health care system that promotes choice, quality, and affordability.
  • Work with states to establish high-risk pools to ensure access to coverage for individuals who have not maintained continuous coverage. 
  • Allow people to purchase insurance across state lines, in all 50 states, creating a dynamic market.
  • Maximize flexibility for states via block grants so that local leaders can design innovative Medicaid programs that will better serve their low-income citizens.

Mr. Trump will likely have the support of some of the biggest insurance companies, such as Anthem, Cigna, Aetna, Humana, and UnitedHealth, who are requesting changes to the law after losing almost $2 billion this year on the individual market.

“There will likely be some concessions made due to lobbying from these poor performing entities,” said Reddy. “However, we believe that the Centers for Medicare and Medicaid Services (CMS) will not budge on its overall payment model, where the expectation is that 50 percent of all CMS payments in 2018 will be capitated and 80 percent of the payments will be quality-based. Otherwise, companies will just stick to the old way of doing things, hoping that the government will keep pushing out or revising their mandates.”

During the campaign, a single-payer option for healthcare was frequently offered as a possibility. Bernie Sanders was a big proponent of a single-payer option and even Hillary Clinton’s website said she would like to “make a ‘public option’ possible.”

“Mr. Trump’s election effectively takes the single-payer option off the table,” said Reddy. “It was already highly unlikely. If a single-payer option happened, it would likely have been a two-payer system where the government paid for basic healthcare, but individuals, who could afford it, had the option to buy “Cadillac” plans with their own money or through employer-subsidized insurance.

“What is very likely is that the ACA is a permanent part of healthcare. This is encouraging. It means that both payers and providers are accountable for the positive outcomes of their members. And while some entities wait passively and hope that government changes are coming, progressive companies will embrace the shift to value-based care and leap ahead of the pack. It’s a shift that will improve patient health and boost profits for payers and providers.” 

To learn how to leverage advanced data analytics to mitigate risk, close gaps in care, and improve member outcomes, click here.

From Obamacare to Trumpcare: The Future of the ACA Under President-elect Trump

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